International Journal of Orthopaedics Sciences 2019; 5(4): 914-917

E-ISSN: 2395-1958 P-ISSN: 2706-6630 IJOS 2019; 5(4): 914-917 A study of greenstick fractures in forearm bones in © 2019 IJOS www.orthopaper.com children Received: 14-08-2019 Accepted: 18-09-2019 Dr. Parimal Patel and Dr. Krunal Chaudhari Dr. Parimal Patel Assistant Professor, Department DOI: https://doi.org/10.22271/ortho.2019.v5.i4p.1797 of Orthopedics, Veer Nirmal South Gujarat University Government Medical College, Abstract Surat, Gujarat, India Background and objectives: Definition: A fracture in which one side of a bone is broken and the other is bent John Insall, a British-American orthopedist and Michal Slupecki, a Polish-American orthopedist, Dr. Krunal Chaudhari described the fracture like that of a breakage of green wood, which simply breaks outer side when bent. Assistant Professor, Department Ligaments and Tendons are stronger than bone when young. Bone is more likely to be injured than soft of Orthopedics, Veer Nirmal tissue. Periosteal is biologically active in children and often stays intact with injury. This stabilizes South Gujarat University fractures and promotes healing. Force to side of bone may cause break in only one cortex–Greenstick Government Medical College, fracture. The outer cortex only bends. In very young children none of the cortex may break–Plastic Surat, Gujarat, India deformation. Methods: Out of 35 cases treated in our instate 23 were male and 12 female child. Patients pre and post

reduction serial follow up x-rays were studied. Follow up period ranges from 3 months to 3 year. In

greenstick fracture reduction done according to angulation of fracture. When the apex of the fracture is towards dorsum of the forearm (apex dorsal- pronation injury), the forearm supinated to achieve reduction. When the apex of the fracture is towards volar aspect of the forearm (apex volar- supination injury), the forearm pronated to achieve reduction. Results: Out of twenty patients treated, overall good to excellent results were obtained in 96% patients. The results was fair in one patient each. There were no intraoperative complications. Interpretation and conclusion: Maximum fractures were in age group of 5-10 year with predominance in males. Most of the fractures were on subordinate side. Average union time in greenstick fracture was 6 week. In this series the highest degree of angulation (at final follow up) which got corrected was in radius 18° and in ulna 13°. Remodeling and returning of final range of motion is excellent.

Keywords: Greenstick, angulation, children, supination, pronation

Introduction Greenstick fracture is defined as a type of fracture where the bone bends and partially breaks. Greenstick fracture usually occurs during infancy and childhood when bones are soft. This fracture was described by John Insall, a British- American Orthopedist and Michal Slupecki, a

Polish-American Orthopedist. They described the fracture like that of a breakage of a green wood, which simply breaks outer side when bent. Angulated Greenstick fracture of the shaft radius and ulna at different levels indicates a significant rotational component of injury. Evans, Rang and others have stated that the apex-volar angulation pattern usually associated with supination type injury mechanism, while most apex dorsal angulation greenstick fracture

involve a pronation type injury mechanism. The objective of treatment in greenstick fracture is to correct angular deformity by simply reversing the forearm rotational forces.

Material and Method We have treated 35 cases in our institute. There were 23 male child and 12 female child. Patients Pre and Post reduction serial follow up x-ray were studied. Follow up period ranges

Corresponding Author: from 3 month to 3 year Dr. Krunal Chaudhari Assistant Professor, Department of Orthopedics, Veer Nirmal South Gujarat University Government Medical College, Surat, Gujarat, India ~ 914 ~ International Journal of Orthopaedics Sciences www.orthopaper.com

Table 1: Level of Bone Fractured

Level No. of Patients Upper 1/3rd 07 Midshaft 08 Lower 1/3rd 13 Lower1/4th 07 Total 35

Fig 3: Both are different of isolate radius and ulna

Plaster Technique In Greenstick fracture reduction done according to angulation of fracture. When the apex of fracture is towards dorsum of forearm (Apex Dorsal-Pronation Injury), the forearm is supinated to achieve reduction. When the apex of fracture towards the volar aspect of forearm (Apex Volar-Supination

Fig 1: No. of Patients Injury), the forearm is pronated to achieve reduction. So depend of injury plaster given in Pronation or in supination. Table 2: Apex of Fracture Angulation Plaster given in oval shaped and with ulnar border straight. Cast Index is maintained. Plaster post reduction check x-ray Level No. of Patients was taken and patient was kept under observation with Volar 30 elevation of limb for 2 days, if there was oedema and stretch Dorsal 5 Ttotal 35 pain at extension of finger, plaster slit from ulnar border and simple bandage was applied over it. If there was no oedema or circulatory disturbance patient was discharge after 2 days. And patient was advice to come after 1 week to check plaster condition.

Results

Table 4: Duration of final follow up

Final Follow Up(month) No.Of Patients 2-8 07 8-14 09 14-20 05 20-26 04 >26 10 Total 35

Table 5: Range of motion at final follow up:

No Of Patients Total Forearm <30 30-50 50-70 >70 Pronation - - 6 29 35

Supination 1 - - 34 35 Fig 2: Show the total volar and Dorsal Table 6: Final result based on objective assesment criteria: Table 3: Bone Involved Results Patients Bone No. of Patients Excellent 26 Isolated Radius 14 Good 08 Isolated Ulna 02 Fair 01 Both 19 Poor --

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Case 1: 7 Year Male

Pre Reduction Post Reduction

6 week follow up 5 month follow up Functional Outcome

Functional Outcome-Excellent

Case 2: 6 Year Male

Pre Reduction Post Reduction, 6 week follow up 6 week follow up 2 year follow up ~ 916 ~ International Journal of Orthopaedics Sciences www.orthopaper.com

Function Outcome-Excellent

Discussion 56. [PubMed] In our study we have taken 35 cases of Greenstick fracture of 6. Schmuck T, Altermatt S, Büchler P, Klima-Lange Ds, forearm bones, in which there were 23 male & 12 female with Krieg A, Lutz N et al. Greenstick fractures of the middle age between 3-13 year, High incidence of Greenstick fracture third of the forearm. A prospective multi-center study. of forearm were found in age group 5-10 year with mean age Eur J Pediatric Surg. 2010; 20(5):316-20. [PubMed] 7 year. Female are less involve than male. 7. Casey PJ, Moed BR. Greenstick fractures of the radius in In present series both bone involved more than isolated bone. adults: a report of two cases. J Orthop Trauma. 1996; Volar angulation is more common than dorsal. In present 10(3):209-12. [PubMed] series lower 1/4th level is more common. Pronation is more common than supination. 17% patient has 10° loss of pronation in our study while one patient has restriction of supination (short term follow up of 2 month). Average period of immobilization is 6 weeks. In present series the highest degree of correction in radius is 18° and in ulna is 13°. In our study 74% has excellent result, 22% has good result & 1% has fair result. None of has poor result.

Conclusion 35 cases of Greenstick fracture for arm bones are studied. Maximum fracture were in age group of 5-10 year with predominance in males. Most of the fractures were on subordinate side. Average union time in Greenstick fracture was 6 week. In this series the highest degree of angulation (at final follow up) which got corrected was in radius 18° and in ulna 13°. There is rare incidence of slitting plaster. Remodeling and returning of final range of motion is excellent.

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